Dr Malpani shares her thoughts on egg-freezing and why women should consider it
Dr Anjali Malpani is a gynaecologist at the Dr Malpani’s Fertility Clinic. Egg-freezing is a common topic in her blogs and she has insightful thoughts to share with the readers of EggChill.
Why should women consider egg-freezing?
Every woman is born with all the eggs she will ever have; when I tell my patients this in the course of their consultation, many of them are genuinely shocked. Men are able to produce new and viable sperm right through their life; by contrast, a woman’s eggs start aging even before birth, and this process of depletion continues until they are finally exhausted at menopause.
Today a number of career-minded women put off motherhood and the fact that they have a depleting egg count can be downright terrifying to them. But that’s not how it needs to be. Modern day reproductive technologies have made possible various options that enable women to have children much later in their life. The key lies in knowing your options, so you can exercise them intelligently.
Egg freezing is now one of the simplest ways in which a woman can radically slow-down her biological clock; this option is one I recommend to young women who are concerned about their fertility.
When is the best time for egg-freezing?
Its best to freeze your eggs when you are in your twenties & thirties. This is because younger eggs are of better quality, which means they will withstand the freeze and thaw procedure better. They also have a much better chance of fertilizing, because their mitochondrial energy levels are higher, which means they provide you a better chance of having a baby.
The trouble is that when women are good candidates for egg freezing – between the ages of 30 to 35, they have so much going on in their life, and rightfully feel that their chances of finding the right person and getting married are so high , that they still not willing to consider the possibility that they may have difficulty having a baby in the bedroom when they want one. The biological clock is still quite muffled at this stage in a woman’s life ! This is why it’s usually when they start crossing 37 that they start exploring all these additional options. They may have heard stories from their friends, who needed to do IVF to have a baby. This is wake-up call for them, and they are prodded into exploring their reproductive desires much more closely.
While we are happy to do egg freezing for any woman, no matter what her age, the reality is that they may not have such a great success rate, and it would have been much better for them to have done it earlier, rather than to have postponed making this decision for so long.
How is the egg-freezing procedure like?
The egg freezing process isn’t all that complex. Once you qualify as a candidate for egg freezing, we will then plan a cycle around your menstrual cycle. As soon as it begins, we begin administering fertility hormones. These are in the form of daily injections and you are required to take them for about 10 days , after which your eggs will be extracted at the clinic. The 30 minute procedure is done under light sedation, is quick and painless. Your eggs are then frozen by the embryologist in the IVF lab, using a flash freezing ( vitrification) protocol. Survival rates are nearly 100%.
Will freezing my eggs now make me run out of them later?
This is a misconception, and a very common one at that. This is because we are only freezing the eggs which you would otherwise have lost. Typically, only one egg gets ovulated each month, but 30-40 follicles start the maturation process. These normally die every month, because they undergo atresia.
With the fertility hormone treatment, we are effectively disrupting this loss , which means we are saving those eggs which would have died under natural circumstances. You also need to keep in mind that the hormonal injections we use are natural hormones, which get excreted promptly, and don’t have any long-term side effects.
What are the success rates of having a healthy baby through frozen eggs?
The success rates of having a healthy baby depend upon many variables, including: the number of eggs frozen ; the quality of the eggs; and the experience and expertise of the IVF clinic doing the egg freezing.
The younger the age at which your eggs are frozen, the better your chances of having a healthy baby with them
While it’s hard to provide precise success rates for an individual woman, the rule of thumb is that a woman less than 35 should freeze approximately 20 frozen eggs to have a chance of about 80% of having a healthy baby. While the survival rate of frozen eggs after thawing is excellent, we need to remember that human reproduction is not an efficient enterprise – and this is true both in the bedroom and in the IVF lab . Thus, about 60% of these eggs will fertilise after thawing when ICSI is done; and about 40% will form Day 5 embryos ( blastocysts). When a blastocyst is transferred, it has about a 30% chance of implanting and becoming a baby.
Since each frozen egg is worth its weight in gold, it’s a good idea to freeze extra eggs, to make sure your safety net is robust – and in case your want more babies in the future ! This means you may need to do 1-3 egg freezing cycles, to give yourself a good chance of having a baby. This will depend upon your ovarian reserve, and whether you have conditions such as PCOD or endometriosis. The rule is simple – more is better !
How long will my frozen eggs last?
Theoretically, forever! The eggs are frozen at -196, which means they are in a state of suspended animation, and will remain here until we thaw them, because all their metabolic activity has been stopped at this low temperature. The technology has been used for over a decade now and there are healthy children from eggs which have been frozen for 5-9 years.
Are babies that have been created using frozen eggs as healthy as all other babies?
Regardless of whether IVF babies have been created using fresh or frozen eggs ( or frozen sperm or embryos for that matter) , they are as healthy as any babies that have been born naturally.
What are the complications?
It’s very important that you take all these medications the way they have been prescribed by your doctor. You may also be asked to avoid sexual intercourse for a certain period of time. The symptoms you should be wary about are:
• Temperature above 39°C
• Severe abdominal pain/swelling
• Severe nausea/vomiting which doesn’t go away
• Heavy vaginal bleeding (though light -bleeding is normal)
• Difficulty urinating/painful urination
Any final words of advice for the readers of EggChill?
It’s great that advances in reproductive technology now offer so many additional options to women, so that they can now control their own reproductive destinies, rather than depend upon the vagaries of nature. Biology is not destiny, and we need to make sure women are made aware of their options, so they can make well-informed choices for themselves.